UM Cardiologist And Researcher Lead Study Identifying Predictors Of Prognosis For Heart Failure Patients

Main Category: Cardiovascular / Cardiology
Article Date: 11 Jul 2008 - 2:00 PDT

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In a discovery that could lead to more successful and personalized treatment, a post-doctoral fellow and the leader of the University of Miami Miller School of Medicine's Cardiovascular Division have published a study that gives physicians a critical tool in predicting the long-term course for heart failure patients. Joshua M. Hare, M.D., chief of the Cardiovascular Division and director of the Interdisciplinary Stem Cell Institute, worked with post-doctoral fellow, Bettina Heidecker, M.D., and eight other physicians to develop a groundbreaking new way to predict clinical outcome of patients with new onset heart failure. Their results are published in the July 15, 2008 edition of the weekly journal Circulation.

Currently available clinical tests for risk assessment and prediction of clinical trajectory in patients with new-onset heart failure are imperfect and there is no agreement on an optimal reliable standard evaluation. Dr. Hare and his group hypothesized that measuring expression levels of specific messenger RNAs in a cell or tissue could be extremely useful for the long-term clinical prediction for a heart failure patient. "Heart failure affects millions of Americans," explains Hare, "so finding a way to distinguish a patient who will survive and recover from those who are in immediate danger is critical."

New technologies have emerged that measure expression levels of the entire complement of messenger RNAs in a cell. These have become extremely valuable in clinical settings in detecting disease etiology, prognosis and therapeutic response because they are highly comprehensive and accurate.

In the current study, Hare and Heidecker collaborated with physicians from The Johns Hopkins Hospital, University of California, Los Angeles, and Brigham and Women's Hospital in Boston. Over a period of ten years, endomyocardial biopsy samples (small pieces of heart tissue obtained with a catheter), were collected from patients, who were evaluated for new onset heart failure. At the same time, a database of clinical assessment was established for all patients. At the end of the study, the biopsies were processed and analyzed with microarray technology. The group developed a molecular signature comprising 45 genes that predicted long-term clinical outcome with very high accuracy.

Using this biomarker, they were able to distinguish patients who survived at least 5 years after first presentation from those who did poorly and required a left ventricular mechanical assist device, cardiac transplantation or who died.

"We hope these findings provide the physician with critical data in the risk assessment of patients," explains Heidecker. "The results of this study could provide tools for personalized treatment or monitoring of heart failure patients that is not currently available in clinical settings."

This study earned Dr. Heidecker the prestigious Samuel A. Levine Young Clinical Investigator Award at the American Heart Association's Scientific Sessions in November 2007.

University of Miami Miller School of Medicine

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